Randomised Controlled Trial between Ultrasound Guided Femoral Nerve Block and Adductor Canal Block for Postoperative Pain and Functional Outcome in Anterior Cruciate Ligament Reconstruction

Kamath, Shaila S; Faiaz, Aghna Faryal

doi:10.7860/jcdr/2019/38453.12478

Cited by 3 publications

(15 citation statements)

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“…This review consistently found no difference in analgesic efficacy between ACB and FNB, 1,2,5,8,9,11,23 which is in agreement with reviews of the literature comparing the 2 blocks in TKA. 18,21,31,35 A 2019 meta-analysis of evidence comparing FNB and ACB in a variety of arthroscopic knee procedures, including ACLR, not only found no difference in analgesic efficacy between the blocks but also found no difference between ACB and placebo.…”

Section: Discussionsupporting

confidence: 89%

“…Nerve blocks were administered preoperatively in 5 trials 1,2,5,23,28 and postoperatively in 3 trials. 8,9,11 The type of graft used was variable, with 5 studies using only bone–patellar tendon–bone (BPTB) autografts 2,5,8,11,23 ; 1 using BPTB and hamstring autografts 1 ; and 1 using quadriceps tendon allografts and autografts, BPTB autografts, and tibialis anterior allografts. 28 One study did not specify the type of graft used.…”

Section: Resultsmentioning

confidence: 99%

“…9 Patient characteristics are presented in Table 3. ACL reconstruction was performed under general anesthesia in 6 studies 1,8,9,11,23,28 and spinal anesthesia in 1 study. 5 One study did not specify the anesthetic modality used.…”

Section: Resultsmentioning

confidence: 99%

“…Follow-up periods for functional outcomes varied significantly. Of the 7 studies including functional outcomes, 2 indicated follow-up for functional measures of 6 months, 2,28 1 reported follow-up at 1 week, 23 3 included follow-up between 24 and 48 hours postoperatively, 8,9,11 and 1 reported follow-up for only 1 hour after administration of the nerve block. 1 Follow-up periods were much less variable for analgesic outcomes, with the majority of studies citing follow-up between 24 and 48 hours 1,2,5,8,9,11 and 1 study presenting data for 4 days after surgery.…”

Section: Resultsmentioning

confidence: 99%

“…Seven studies evaluated functional capacity as a primary or secondary outcome of interest; 1,2,8,9,11,23,28 however, there was significant variability in the measures used by each study. Each reported some measure of quadriceps strength as being indicative of functional capacity.…”

Section: Resultsmentioning

confidence: 99%

See 4 more Smart Citations

Effect of Adductor Canal Block Versus Femoral Nerve Block on Quadriceps Strength, Function, and Postoperative Pain After Anterior Cruciate Ligament Reconstruction: A Systematic Review of Level 1 Studies

et al. 2019

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Background: Femoral nerve block (FNB) is a popular technique for reducing postoperative pain in patients with anterior cruciate ligament reconstruction (ACLR), but it is also linked to a number of adverse effects, such as quadriceps weakness, antalgic ambulation, and increased fall risk. Adductor canal block (ACB) has been offered as a motor nerve–sparing alternative to FNB. Purpose: To evaluate available literature that compares the effects of ACB and FNB on functional outcomes after arthroscopic ACLR. Study Design: Systematic review. Methods: Following the 2009 PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines, a search of PubMed (Ovid), CINAHL, Scopus, Cochrane, and Google Scholar databases was conducted. Search terms were designed to capture studies comparing the effects of ACB and FNB in patients undergoing arthroscopic ACLR. Data were evaluated regarding study and patient characteristics, functional measures, opioid consumption, pain scores, and complications. Results: Eight randomized controlled trials (N = 655 patients) comparing the efficacy of ACB versus FNB in arthroscopic ACLR were included. The heterogeneity of outcome measures precluded meta-analysis. Seven studies reported functional measures, which included isokinetic strength, straight-leg raise, and other various measures. Follow-up periods varied between 1 hour and 6 months. In 3 trials, ACB was found to preserve quadriceps strength as measured using straight-leg raise for the first 12 to 24 hours after surgery, while 3 other trials found no difference between the groups. No differences were reported in isokinetic strength at 6 months. In other functional measures, ACB either outperformed or was equivalent to FNB. The majority of studies reporting opioid consumption, pain scores, and complications found no differences between the blocks. Conclusion: This systematic review suggests that when compared with FNB, ACB preserves quadriceps function in the early postoperative period after ACLR while providing a similar level of analgesia. Limitations of this study include the use of various functional measures and limited long-term follow-up. More research evaluating long-term functional outcomes with standardized measures is needed to draw adequate conclusions regarding the effects of ACB and FNB on function after ACLR.

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Section: Discussionsupporting

confidence: 89%

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

See 3 more Smart Citations

Effect of Adductor Canal Block Versus Femoral Nerve Block on Quadriceps Strength, Function, and Postoperative Pain After Anterior Cruciate Ligament Reconstruction: A Systematic Review of Level 1 Studies

et al. 2019

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The Effectiveness of Adductor Canal Block Compared to Femoral Nerve Block on Readiness for Discharge in Patients Undergoing Outpatient Anterior Cruciate Ligament Reconstruction: A Multi-Center Randomized Clinical Trial

ten Hoope,

Admiraal,

Hermanides

et al. 2023

JCM

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This study evaluated the effect of adductor canal block (ACB) versus femoral nerve block (FNB) on readiness for discharge in patients undergoing outpatient anterior cruciate ligament (ACL) reconstruction. We hypothesized that ACB would provide sufficient pain relief while maintaining motor strength and safety, thus allowing for earlier discharge. This was a randomized, multi-center, superiority trial. From March 2014 to July 2017, patients undergoing ACL reconstruction were enrolled. The primary outcome was the difference in readiness for discharge, defined as Post-Anesthetic Discharge Scoring System score ≥ 9. Twenty-six patients were allocated to FNB and twenty-seven to ACB. No difference in readiness for discharge was found (FNB median 1.8 (95% CI 1.0 to 3.5) vs. ACB 2.9 (1.5 to 4.7) hours, p = 0.3). Motor blocks and (near) falls were more frequently reported in patients with FNB vs. ACB (20 (76.9%) vs. 1 (3.7%), p < 0.001, and 7 (29.2%) vs. 1 (4.0%), p = 0.023. However, less opioids were consumed in the post-anesthesia care unit for FNB (median 3 [0, 21] vs. 15 [12, 42.5] oral morphine milligram equivalents, p = 0.004) for ACB. Between patients with FNB or ACB, no difference concerning readiness for discharge was found. Despite a slight reduction in opioid consumption immediately after surgery, FNB demonstrates a less favorable safety profile compared to ACB, with more motor blocks and (near) falls.

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Comparative Study of Adductor Canal Block and Femoral Nerve Block for Postoperative Analgesia After Arthroscopic Anterior Cruciate Ligament Tear Repair Surgeries

Dixit¹,

Prakash²,

Yadav³

et al. 2022

Cureus

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Objective: The study aimed to compare an adductor canal block (ACB) with a femoral nerve block (FNB) with regard to their analgesic efficacy and the quadriceps muscle strength in patients following arthroscopic anterior cruciate ligament (ACL) tear repair surgeries. Materials and Methods: Ninety patients in the American Society of Anaesthesiologists (ASA) status I or II undergoing arthroscopic ACL tear repair surgeries under subarachnoid block were divided into three groups to receive ACB (Group ACB), FNB (Group FNB), and control (Group C). Each patient was assessed for Visual Analogue Scale (VAS) score, tramadol consumption, and quadriceps muscle strength postoperatively in the post anaesthesia care unit (PACU). Results: There was no significant difference between the Group ACB and Group FNB regarding postoperative analgesia and total rescue analgesic consumption at 24 hrs postoperative. The mean VAS score at two, four, and six hours and total rescue analgesic consumption in 24 hrs were higher in the control group, which was statistically significant (p-value <0.05). Quadriceps muscle strength by straight leg raise test was significantly higher in the Group ACB compared with the Group FNB at 0, 6, 12, 18 hours postoperatively (p-value <0.0001), whereas the difference between both study groups become statistically insignificant at 24 hours postoperative. Conclusion: ACB preserved quadriceps muscle strength better than FNB, without a significant difference in postoperative analgesia after arthroscopic ACL tear repair surgeries.

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Randomised Controlled Trial between Ultrasound Guided Femoral Nerve Block and Adductor Canal Block for Postoperative Pain and Functional Outcome in Anterior Cruciate Ligament Reconstruction

Cited by 3 publications

References 0 publications

Effect of Adductor Canal Block Versus Femoral Nerve Block on Quadriceps Strength, Function, and Postoperative Pain After Anterior Cruciate Ligament Reconstruction: A Systematic Review of Level 1 Studies

Effect of Adductor Canal Block Versus Femoral Nerve Block on Quadriceps Strength, Function, and Postoperative Pain After Anterior Cruciate Ligament Reconstruction: A Systematic Review of Level 1 Studies

The Effectiveness of Adductor Canal Block Compared to Femoral Nerve Block on Readiness for Discharge in Patients Undergoing Outpatient Anterior Cruciate Ligament Reconstruction: A Multi-Center Randomized Clinical Trial

Comparative Study of Adductor Canal Block and Femoral Nerve Block for Postoperative Analgesia After Arthroscopic Anterior Cruciate Ligament Tear Repair Surgeries

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